module 9 musculoskeletal injuries Flashcards
strain
small tear to muscle or tendon
tendon
muscle to bone
sprain
injury to ligament
ligament
bone to bone
rupture
all fibers of tendon torn
grade 1 ligament injury
mild: stretching injury without instability
grade 2 ligament injury
moderate: severe injury with instability but some fibers still intact
grade 3 ligament injury
complete disruption of ligament
ligament injury s/s
sudden tearing or popping sensation
pain with wt bearing
acute swelling
ligament injury tx
relief of s/s
protect ligament
with grade 3: possible surgery
tendon injury
happens when stress placed on tendon is greater than fibers can tolerate
Joint capsule injury
- after injury the increase in vascularity leads to fibrous tissue development and thickening of capsule
- scarring leads to decreased ROM
- prolonged immobility leads to decreased mobility and extensibility with subsequent loss of motion
effusion
increase in synovial fluid, can lead to stretching of capsule and ligaments
contracture
fatty tissue proliferates joint space
- increased connective tissue leads to adhesions that limit movement
adhesive capsulitis
loss of function in shoulder after injury leading to “frozen shoulder”
- injury -> inflammation -> swelling and distention of capsule
- prolonged immobilization -> thickening of capsule -> proliferation of fibroblasts and capsular contraction
- tightness and loss of movement
- excessive movement -> tearing
adhesive capsulitis tx
conservative
- intraarticular corticosteriod injections
- gentle stretching, PT
- antiinflammatories
- prevenatitive: avoid prolonged immobilization, early gentle stretching
Injuries to inert soft tissue structures
meniscal tear
labrum tear
disk tears
- all cause restrictions of joint and may -> tissue dysfunction in the form of weakness, loss of motion, pain
fasciae injury
sheath that envelopes muscle
- cause edema and scarring
- restrict movement -> restricted joint function
bursae injury
pockets lined with synovium between muscles and tendon/ligament
- faulty mechanics, repetitive movement, direct trauma
- – inflammation: bursitis: pain, disruption of movement, capsular and or muscle dysfunction related to edema
tendinitis
inflammation of tendon
tendinosis
degradation of collagen fibers
epicondylitis
inflammation of tendon where it attaches to bone
blunt trauma
soft tissue contusion or crush injury
- compromise contractile function of muscle
- any trauma that leads to bleeding into belly of muscle
- potential to coagulate and calcify
myositis ossificans
abnormal calcification in muscle
prevents normal and strong contraction of muscle
blunt trauma tx
rest, ice, compression
later: surgical removal of calcification if needed
compartment syndrome
due to trauma of soft tissue caused by unyielding structure of inert tissue
muscle and nerves become ischemic
- excruciating pain and tissue damage
3 categories of compartment syndrome
decrease compartment size
increase compartment content
externally applied pressure
rhabdomyolysis (myoglobinuria)
life threatening complicatoin of severe muscle trauma with muscle cell loss
- crush syndrome
- compartment syndrome
- other: malignant hyperthermia, infection, snakebite, cocaine, adverse effects of meds, long periods of immobility and unresponsiveness
oblique fx
rotational force
oblique break
no rotation around bone
occult fx
hidden
comminuted fx
more than one fx
more than 2 pieces
spiral fx
rotational force
“s” around bone
transverse fx
straight 90 degree
greenstick fx
pediatric population
incomplete break
impacted fx
excessive force that drives one fragment into other
longitudinal fx
split along length
stress fx
failure of one cortical surface of bone, often caused by repetitive action (running)
avulsion fx
separation of a small fragment of bone at site of attachment of ligament or tendon
fx in peds
through shaft of long bone, could stimulate bone growth
- pay attention to alignment
- bony overgrowth or skeletal arrest an lead to different limb lengths
- near joint line: potential for disruption of long bone growth
crush/ compression
associated with cancellous bone
- doesn’t tolerate
- buckles then cracks
displaced fx
ends separated
non-displaced fx
fragments aligned
depressed fx
displaced below the level of the surface of the bone, usually in skull
complete fx
through whole thickness of bone
incomplete fx
cortex buckles or cracks, bone continuity not disrupted
compound
open
simple
closed
open/compound fx classification
type 1: wound < 1cm, minimal contamination
- simple transverse or oblique fx
type 2: wound > 1cm, moderate contamination
- moderate comminution or crush fx
type 3: large amount of contamination
- fx severely comminuted and unstable
- soft tissue damage; muscle, skin, neurovascular
type 3A: soft tissue coverage of fx is sufficient
type 3B: loss of soft tissue + periosteal stripping and bone exposure
type 3C: arterial injury requiring repair, regardless of extent of soft tissue injury
fx tx
initial - ice - elevation - immobilization 2 main goals - reduction - immobilization -- cast, splint surgical intervention - open fx - debridement - multiple injuries interarticular: surgical fixation to perserve joint prophylatic abx and tetnus rehab
complications of fx
delayed healing - delayed union - malunion - nonunion osteonecrosis osteomyelitis comartment syndrome fat emboli syndrome DVT and PE neurovascular injury
osteonecrosis
compromised circulation -> ischemia and death of bone tissue
osteomyelitis
severe bone infection, can occur with open fx -> invasion of bacteria into bone
compartment syndrome breakdown
-accumulation of pressure
- injury to tissue surrounding bone -> soft tissue inflammation-> swelling sometimes hemmorhage
- increase pressure within compartment -> decreased blood flow related to arterial damage -> hypoxia -> capillary integrity decreased -> colloids and fluid escape -> increased swelling -> increased pressure
if tissue pressure > vascular pressure -> vascular collape -> impeding blood flow -> hypoxia -> edema
compartment syndrome tx
emergent decompression: fasciotomy to perserve limb
compartment syndrome s/s
pain pallor paralysis no pulse parethesia
fat emboli syndrome
after fx fat particles release form bone marrow into bloodstream and lodge in lungs
-24-72 hours after trauma
fat emboli syndrome s/s
SOB tachypnea hypoxemia fine petechial rash altered mental status dx: - CT or ventilation-perfusion scan - CXR nml
DVT and PE
thrombus in extremity, clot fragments break off and lodge in lung
highest risk:
- pelvic or long bone fx with >5 days immobilization
- obese pt
- hx DVT
- increased risk of clotting
DVT and PE tx
ventilatory support
anticoags
compression device
early mobilization
neurovascular injury
may be due to fx or tx of fx occuring at time of trauma - force causing fx - hemorrhage - joint dislocation - body position after trauma related to tx: - moving or splinting fx - manipulation during reduction - cast of splint - hemorrhage or edema
dislocation
displacement of bone from normal position
- articulating surfaces lose contact
subluxation
displacement of bone from normal joint location
- articulating surfaces partially lose contact
dislocations and subluxations reason and s/s
occur when forces cause one aspect of joint to move beyond normal anatomical limit s/s: - pain - alteration of normal contour - change in length of extremity - loss of normal mobility
osteopenia
condition where bone mineral density is lower than normal
osteoporosis
loss of both compact and spongy bone
- bone resorption exceeds bone growth
- bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass
- presence of a fragility fx: falls form own height of standing
types: - postmenopausal
- secondary
- regional
causes of osteoporosis
menopause
- decrease estrogen -> increased osteoclast activity
effects of aging
- decreased replicative activity of osteoprogenitor cells
- decreased synthetic activity of osteoblasts
- decreased biological activity of matrix bound growth factors
- decreased physical activity
risk factors for osteoporosis
nonmodifiable:
- advanced age
- female
- european or asian decent
- family hx
modifiable
- ETOH/tobacco/nutrition
- Vitamin D deficiency
- underweight/inactive
- endocrine dysfunction
- certain meds
osteoporosis and chronic renal disease
pts often have parathyroid dysfunction and altered vitamin D metabolism -> decreased bone mass
osteoporosis s/s
often asymptomatic till fx
- colles fx of wrist
- femoral or hip fx
- vertebral comression fx
- kyphosis (hump)
- decreased stature
- impaired breathing
- poor dentition
osteoporosis tx
moderate regular exercise
PT
Ca and Vit D supplement
antiresorptive agents
osteomalacia
softening of the bones due to defective bone mineralization
- secondary to inadequate amounts of available phosphorus and Ca
- due to overactive resorption of Ca from the bone due to hyperparathyroidism
causes of osteomalacia
nutrition deficiency genetic abnormalities tumor inducing vitamin D deficiency - malabsorption - liver disease - ESRD
tx of osteomalacia
correction of deficiency
adequate Vitamin D, Ca, and Phosphate
Paget disease (osteitis deformans)
excessive resorption of spongy bone and accelerated formation of softened bone; inadequate formation of new bone.
- disorganized, thickened, but soft bones
- most often affects the axial skeleton
Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve
paget disease s/s
nothing early
- pain: severe and persistant
- fatigue
- joint stiffness
paget disease tx
reduce pain
prevent deformity and fracture
- calcitonin and bisphosphonates
osteomylitis
infection of the bone
- initial site of infection
- subperiosteal abscess covers and then surrounds site -> blocked blood supply
- sequestrum: dead bone at original site, encapsulated
- involucrum: new bone formation around dead bone and pus. -> prevention of effective abx therapy
exogenous osteomyelitis
spreads form soft tissue to adjacent bone
chronically ill, diabetic, alcoholic, immunosuppressed
S. aureus
Pasteurella multcida
Endogenous osteomyelitis
pathogens carried in blood (hematogenous)
common complication of sickle cell and low O2
cutaneous, sinus, ear, dental, artificial joint infection
S. areus
H. influenzae
Salmonella
gram negative bacilli
osteomyelitis s/s
Children hematogenous - high fever - pain at site - muscle spasm - redness/swelling - refusal to move limb Adult hematogenous - fever - malaise - night sweats - weight loss - anorexia - pain at rest
osteomyelitis tx
4-6 week IV abx
debridement
bone graft
bone tumors
fibroblast
- osteoblast (bone precursor)
— osteogenic tumors “osteo in name”
- chondroblast (cartilage cell precursor)
— chondrogenic tumors “chondro in name”
- fibroblast (collagen producing cell)
— collagenic tumors “fibro in name”
Reticulum
-various blood cell precursors in bone marrow
— myelogenic tumors: giant cell tumor, ewing sarcoma
benign bone tumors
osteoma
chondroma
osteochondroma
osteoclastoma: giant cell tumor
osteoma
small bony tumor on bone surface
- 20 year olds
- dull pain, worse at night
chondroma
tumor made of cartilage
- found incidentally not till adulthood
osteochondroma
cartilage capped tumor with bony stalk.
- found incidentally not till adulthood
osteoclastoma/ giant cell tumor
may invade bone and cause bone destruction
epiphysis of femur, humorus, tibia, radius
Malignant bone tumors
bone marrow: leukemia or myeloma
ewing sarcoma
metastases
Ewing sarcome
malignant tumor of cartilage
children and young adults
- 5-25 years old
metastases
most common malignancies found in bone
chondrosarcoma
cartilage cells men < women -30 to 60 year olds almost 100% reoccurence - amputation best option - proximal humerus - proximal femur - iliac crest - ribs/scapula
osteosarcoma
formation of bone or osteoid by tumor metaphysial region of long bones most common primary malignant bone tumor - 20-30 year olds - humerus, femur, tibia - surgical resection or amputation
multiple myeloma
most common primary tumor of bone
elderly adults
